Nobuo Yamagami

Isolated Plantar Dislocation of the Intermediate Cuneiform Bone: A Case Report

The intermediate cuneiform bone lies between the medial and lateral cuneiforms and has a strong ligamentous attachment to the first metatarsal. It is recessed to anchor the base of the second metatarsal and forms the keystone of the Lisfranc (tarsometatarsal) joint1. Isolated dislocation of the intermediate cuneiform is regarded as a variation of a Lisfranc fracture-dislocation2,3, and only eight cases have been reported in the literature1-8. Because the intermediate cuneiform is wedge-shaped in the coronal plane with its base positioned dorsally, it has a tendency to dislocate dorsally. In fact, seven of the eight previously reported cases were dorsal dislocations1-6,8, and in only one case was the direction of dislocation plantar7. We report a second case of isolated plantar dislocation of the intermediate cuneiform bone. Our patient was informed that data concerning the case would be submitted for publication. A fifty-six-year-old man who worked as a crane operator was injured when the 300 kg of iron material that he was attempting to lift with a crane fell from a height of 2 m onto the dorsum of his left foot. He was immediately brought to our hospital with severe foot pain. Physical examination showed severe swelling of the left foot, without an open wound, and demonstrated tenderness of the plantar and dorsal surfaces of the midfoot. The patient had no sensory or motor disturbances. Plain radiographs showed an isolated plantar dislocation of the intermediate cuneiform bone, with slight displacement of the first metatarsal (Fig. 1). A computed tomographic scan (Fig. 2) with three-dimensional reconstruction showed a complete dislocation of the intermediate …

Optimum suture material for locking technique in tendon repair: Effects of suture friction in mobilization

BACKGROUND The 2-strand side-locking loop technique allows secure locking formation easily, yielding maximum tensile force. However, not all suture materials are suitable for this technique. METHODS The bovine gastrocnemius tendons were transected and repaired end-to-end by the side-locking loop technique using USP2 braided polyblend, braided polyester, monofilament nylon, braided nylon, or monofilament absorbable polydioxanone sutures. A repetitive loading protocol from 10N to 100N was used, and the loading was repeated 10,000 times. In ruptured samples during the repetitive loading test, the number of loading was recorded. In samples which did not rupture, the ultimate tensile strength was measured after repetitive loading. After testing, ruptured sutures were examined microscopically. For comparison of ultimate tensile strength before and after repetitive loading, we performed a one-time loading test on samples which did not undergo the repetitive loading. FINDINGS With monofilament nylon, braided nylon, or monofilament absorbable polydioxanone, suture rupture occurred during repetitive loading. In contrast, no suture rupture occurred with braided polyblend or braided polyester. Microscopic observation showed abrasion of the surface in braided polyester, though the friction effects were not seen with braided polyblend. The mean ultimate tensile strength before and after repetitive loading was 395N and 399N, respectively, for braided polyblend. For braided polyester, they were 208N and 174N, respectively. INTERPRETATION Braided polyblend suture material has an excellent resistivity to friction and is suitable for the side-locking loop technique.

Usefulness of braided polyblend polyethylene suture material for flexor tendon repair in zone II by the side-locking loop technique.

Flexor tendon injuries in zone II were treated in 14 fingers of 13 patients with our method. Firstly, a 2-strand core suture was made by the side-locking loop technique using a USP 2-0-sized braided polyblend polyethylene suture, then 7-strand peripheral cross-stitches were added using a USP 5-0-sized monofilament nylon suture. Post-operative exercises included passive flexion and extension without external fixation on the next day of surgery. Average follow-up observation period was 18 months. As results, the Strickland method of assessment for surgical outcome showed excellent in eight digits and good in five digits, though there was a poor outcome in one digit. Our suture method enabled early post-operative mobilisation exercise without using a splint, while preventing adhesion between the repaired tendon and peripheral tissues, which is considered to provide far greater ultimate tensile strength and a smaller gap at the sutured site than by the conventional method.